by Kyoko Mori
In America, I feel confused by large-scale public issues: the state of the environment, the various plans to cut taxes or to decrease government spending, the decline or the improvement of public education, the gap between the rich and the poor. These issues are as overwhelming as the large public places where I get lost: shopping malls, stadium parking lots, or highway interchanges, many of which have misleading or badly lit signs. I am irritated by the newspaper or television equivalents of those bad signs—headlines that make local and road construction seem more important than the peace talks in the Middle East, thirty-minute hometown news shows that update the weather four times even when conditions are normal. I often wish that I could get better information, but I don’t lose sleep over bad news coverage. I don’t expect to be an expert on every public issue.
My immediate private life is a different matter. I have a very high standard of knowledge when it comes to my own life. Even though I may be confused about how my senator voted on the last health care or tax reduction bill, I expect to be well informed about my health, bank accounts, debts, or legal rights. No one in America likes to be kept in the dark about his or her health, money, or legal rights and told to trust; very few people choose to remain ignorant. I am no exception.
My Japanese relatives don’t share the same eagerness for knowledge, even in life-and-death situations. Both my father and his sister remained ignorant about their cancers until they died. No one told them and they asked no questions. If they sensed that they were dying, they didn’t talk about it. Neither did their doctors—at least not to Hiroshi and Akiko themselves.
In Japan, doctors usually inform the immediate family of terminally ill patients and ask them to keep quiet. The patients, the doctors advise, may lose heart and die in a few weeks if they find out the truth. “Don’t discourage them and shorten their lives,” the doctors warn. “Besides, they should be happy and content in the short time they have left, not worried and afraid.” Most families agree. They tell the truth to relatives, old friends, and a few business associates, but always with a warning: “Of course, he/she doesn’t know, so don’t let on.”
My American friend Vince, who teaches in Japan, once told me about a friend who had cancer but didn’t know about it until he finished his two-year appointment at a Japanese college and went back to the States. His friend had consulted a Japanese doctor about his stomach pains and had had some tests done. In retrospect, Vince’s friend was sure that his Japanese doctor had known about his cancer from these tests but had never told him.
Hearing this story, I felt angry. If I were dying, I thought, I would want to be the first to know the truth. I should be the one to tell my family and friends. In Japan, the whole order is reversed: doctors make decisions for you without your knowledge, and families tiptoe around an obvious truth, everyone wrapped in polite silence. The assumption behind it—that people don’t know what is best for themselves—scares me.
Vince and I had this discussion the same year Hiroshi and Akiko became ill. Akiko had surgery because something was wrong with her liver. Neither she nor her daughter Kazumi mentioned cancer. Hiroshi, too, was hospitalized for nine weeks. He and my stepmother told me that he had had surgery to remove benign polyps from his intestines.
I suspect now that both my father and my aunt already had cancer back then and had surgery to remove the tumors. But because I was talking to them in Japan, in Japanese, it didn’t occur to me to try to know more than I was told. I never made the connection between Vince’s story and my family’s illness. Maybe that’s the real danger of speaking and thinking in a constant cloud of polite vague language: the language numbs my thinking. I stop raising questions, even to myself. When my brother called in April 1993 to say that our father had died from cancer, I was completely surprised.
As it turned out, my father recovered well from his initial surgery and was back to his normal health for about a year and a half. Then his cancer returned and he had several operations to remove more tumors. In October 1992, after one of these operations, the doctor finally told my stepmother that my father had cancer, that the tumors were too widespread for additional surgery or treatment. The doctor predicted that Hiroshi could still live for a year—and told Michiko to say nothing to him. My stepmother told Akiko and a few of Hiroshi’s business friends; when my brother returned from South America, she told him, too. Akiko wanted Michiko to telephone me, but Michiko decided against telling me anything. While Akiko was trying to find ways to notify me—without directly going against Michiko’s wishes—my father died.
I resent Michiko for not having told me. But at least I understand why she kept a secret from me. Michiko never liked me. She was happy that my brother and I were on distant and even hostile terms with Hiroshi. She often reminded us about how the three of us never got along. She loved to tell stories about the things I said when I was thirteen or fourteen—how I told my father that if I’d had a choice, I would rather not have been born than be born his daughter. It’s no surprise that she didn’t want me to know that my father was dying. She was afraid that I might decide to visit him and that we might come to some understanding. If I knew the truth, maybe I would try to make peace. After years of making our already bad relationship worse, she didn’t want a last-minute reconciliation between us.
Michiko’s secrecy was hostile and malicious. That kind of secrecy is not unusual; withholding information is the way a lot of people hurt and manipulate others. Michiko’s behavior angers me but there is nothing puzzling about it. What I can’t understand is the polite secret everyone—not only Michiko but also Akiko and my brother—kept from Hiroshi while he was dying. They said nothing because they didn’t want to scare or hurt him. Their intention was the opposite of malice.
Michiko, Akiko, Jumpei, and the doctors weren’t the only people keeping secrets. Hiroshi himself must have known that he was seriously ill, that he was dying, that the numerous operations he’d had were to remove malignant tumors. In Japan, doctors keep patients in hospitals for several weeks after even minor surgery. Hiroshi convalesced for nine weeks after the removal of his supposedly benign polyps. And yet he was sent home a few weeks after his last surgery, and the doctors didn’t recommend any more treatment. Being sent home so easily is a sign that you are not expected to recover. Hiroshi must have realized the seriousness of his illness, but he never asked his doctors or his family to tell him more. Perhaps he was afraid. Or else he did not want to put Michiko, Jumpei, or Akiko in the awkward position of having to lie to him. My father was not a fearful or polite person by nature. For him to keep up his end of the mutual secrecy and pretense pact, the taboo against demanding the truth must have been potent.
The code of silence demands a lot of trust. To ask no questions about your own health, you have to trust that other people know better and mean well, whether those other people are your family or your doctor. This is something I am simply unable to do, and yet most of my relatives seem to find it easy, even natural.
During the week I spent at Akiko’s house after my father’s death, I began to see that she, too, was ill. The third morning of my stay, I got back from my morning run and found her sitting in the kitchen in her blue flannel pajamas. Hunched over the table with her fingers around the tea cup, she looked like someone on the verge of freezing to death.
“I don’t feel very well this morning,” she told me, shivering. “I’m going to lie down for a while.” She unscrewed a medicine bottle, took out a couple of pills, and swallowed them with her tea.
Before I left for my run, she had been dressed in her sweater and slacks, busily dusting the bookshelves in the living room. Because she had said nothing about her own health, I assumed that while my father had not recovered from his illness, my aunt had. The first two days of my visit, my aunt had gone out with us to restaurants and coffee shops, showing no sign of being ill. But as I watched her taking her medicine that morning, I wondered if she, too, might have cancer or something equally serious.
&
nbsp; “Are you all right?” I asked. “What’s the medicine for?”
“My liver,” she replied, capping the bottle and putting it back on the table.
“You still have problems with your liver?”
She nodded.
“Do you know what’s wrong?” I asked.
“Oh, nothing much,” she replied, smiling weakly.
“But you said you didn’t feel well.”
She sighed. “I don’t feel that bad, but my doctor doesn’t want me to get too run down. ‘Anytime you feel tired,’ he told me, ‘go lie down for a few hours at least.’ He says I can’t expect to be the same as before.”
What she said sounded vague, the way old people talk about their health. Akiko was only sixty-three. “How do you mean?” I pressed. “You can’t be the same as before what?”
“That surgery really took a lot out of me,” she said.
“But the surgery was three years ago.”
Akiko poured herself another cup of tea. “At my age and with my problems,” she continued after a while, “I’m lucky if I can be up and active for a couple of days and then lie down and rest the next day. My doctor tells me to be careful. ‘Either you learn to take it easy at home,’ he threatens me, ‘or I’ll make you check in and rest at the hospital.’”
Akiko went to her room, closed the door, and slept for the rest of the day—but then she got up and went to dinner with Kazumi and me. We stayed up late talking. The next day, Akiko was up before Kazumi or me; she was sweeping the hallway with her broom when I got up. She appeared perfectly healthy again.
For the rest of the visit I felt confused—I couldn’t tell if she was actually ill or just run down and tired. Every Saturday she went to the hospital for tests. I asked her what the tests were for. “Nothing serious,” she said, her favorite phrase in discussing her health. I had no idea what she meant. She could have been saying that she wasn’t seriously ill, or that the care she was receiving was routine and acceptable, or something entirely different.
One detail my aunt repeated was that she would have to be hospitalized if the doctor didn’t like the results of her weekly tests, but I didn’t know what that meant, either. It isn’t unusual for Japanese doctors to recommend hospital stays for patients “to rest and take it easy” whether or not they are seriously ill. After a few weeks of bed rest and additional tests, most patients are sent home without a clear explanation of what was wrong in the first place. No one complains—all assume that their condition must have improved after being under the doctor’s care.
I was alarmed by Akiko’s unconditional trust in her doctor. Rather than trying to understand the tests so that she, too, could consider her options, she was prepared to follow the doctor’s orders—whether for surgery, hospital stay, or simply lying down in her own room, in her own house. In many small ways, I was sure, she was choosing not to know more. She used vague phrases and platitudes to cloud her own thinking. She never asked the doctor to explain the results of her tests or the reason for prescribing so many pills. I couldn’t understand how she could avoid asking these questions. I would never allow anyone to take my blood without telling me what the test was for and promising to go over the results with me. I could not imagine handing over my health to someone else. Watching my aunt, I was afraid that she was giving up on herself. I would have been less puzzled if she had seemed fearful—afraid to find out the truth—but when we talked about her health, her tone was always vague but peaceful. That was what scared me the most: how calm she seemed, almost indifferent.
I saw Akiko a few times after that visit, and each time she appeared the same—cheerful and active one day, tired and pale the next. I stopped asking her or Kazumi any questions. Either they didn’t know what was going on or they didn’t want to tell. Only after Akiko’s death—in May 1996—did I ask Kazumi, when the two of us were having dinner at a Chinese restaurant we used to go to with Akiko.
“My mother had cancer,” Kazumi said, “but that wasn’t what she died of. She had a swelling in her veins, which caused a lot of hemorrhaging. She got very weak. I’m sure she sensed that she wasn’t going to be around very long. Since March, she kept having to go in and out of the hospital because of the hemorrhage, but the end was sudden. She didn’t suffer much.”
Just as Kazumi finished talking, the waitress appeared with our first course, a cream soup that was Akiko’s favorite. I didn’t really understand what Kazumi said. With all the details she gave me, her explanation was still oddly vague. I wasn’t sure why she felt the need to say that it was not the cancer that had killed her mother. Still, I knew that Kazumi had said all she wanted to say. The most important thing she said was the last thing, “She didn’t suffer much.” I waited until the waitress was gone, then nodded and smiled. After a brief silence, I said it was good that Kazumi had been there to take care of her mother.
“It seems like a long time since her first surgery, though,” Kazumi said, as she reached out to pour the soup from the big tureen the waitress had brought. “That was six years ago. I thought she was going to die then.”
“She recovered very well after that, right?”
“Yes, Kazumi said.
After hesitating a little, I asked, “How did you know she had cancer?”
In silence, Kazumi poured the soup into my bowl. She handed me the bowl before replying, “After the surgery, the doctor said to me, ‘Well, it might have been cancer, but whatever it was, it’s all gone.’”
“Might have been?”
“That’s how he put it, anyway.” Kazumi shrugged. “I told my mother what he said, and she didn’t say much about it.”
I looked down at my soup—thick, yellow liquid in a white bowl—and said no more. Our spoons dipping into the bowls and scraping faintly against the sides, we ate without speaking for a few minutes before going on to other topics—my trip, the flower arrangement classes Kazumi teaches, my brother. We were two polite girls raised in Ashiya; we didn’t dwell on death or illness at dinner. We had been taught to avoid saying bad-luck words like death, sickness, or grief in any conversation.
But I was upset and angry that a Japanese doctor would tell his patients that they “might have had” cancer. The polite ambiguity sickened me. I remembered hearing that in Japan, where even doctors exaggerate the hereditary nature of illnesses, people are ashamed of having cancer in the family. Maybe that’s why Kazumi insisted that Akiko did not die from cancer—she was trying to protect me from worry or shame. Politeness was always a barrier in our family. My cousin and I could never be completely honest with each other no matter how close we were. Kazumi hadn’t called me when Akiko was dying because she didn’t want to worry me, but I wished she had chosen otherwise. If she had told me, I would have flown back to visit one last time.
Being thoroughly Japanese, Kazumi thought of pain as something to be avoided, something to protect people from as much as possible. Being only partially Japanese in my thinking, I accept facing pain as a duty I must perform to remain honest, a test of my courage or integrity. But I also understand what Kazumi was trying to say when she repeated, several times that night, “I’m so glad you were able to see my mother last year when we all had dinner in Kobe. She was still very healthy then. You were able to see her then.”
One of the hardest things about living between two cultures is trying to decide what I can accept as different but well intentioned and what I cannot tolerate regardless of cultural differences. I accept my relatives’ and friends’ attempts to spare me a painful truth or an uncomfortable situation, even if their choice would not be mine. I can never feel the same tolerance toward institutions or society in general. Institutions that influence our health or financial well-being—and people who work for them—have an obligation to tell the truth.
In Japan after my father’s death, I realized that financial information was as difficult to obtain as medical. Because my paternal grandfather, Tatsuo, had died two months before my father, my family had both estates to div
ide among five people: my stepmother, Akiko, Kazumi, my brother, and me. I was prepared to say that I wanted nothing if Akiko and Kazumi could have all my grandfather’s money and the house in which the three of them had lived. Michiko and my brother could split my father’s estate in any way. I wasn’t being altruistic. I was being Japanese. Like everyone else in the family, I wanted a smooth solution without any embarrassing bickering. Even though I was sure that everyone had similar ideas about the division, I knew how hard it would be to proceed, since none of us—according to the Japanese code of politeness—could talk directly about money, a rude and crass topic to bring up among family or friends.
The one thing I counted on was that at least the banks and insurance companies would be very businesslike and efficient. I couldn’t have been more wrong.
On my second day in Japan, Jumpei came over to Akiko’s house to invite Akiko and me to Michiko’s house. He said that Michiko wanted us to pay respects to my father’s spirit at the altar and have tea with her afterward. Akiko, Jumpei, and I walked over to Michiko’s. After we burned incense at the altar, Michiko asked us to sit down at the kitchen table and served us tea and melons. A few minutes later, she abruptly left the table, went to her room, and came back with some papers in her hand.
“I need your signature,” she said, placing the papers on the table in front of me. She began to clear the table, plates and cups clattering in her hands.
The one-paragraph document was printed on the letterhead of a local bank. At the bottom of the page, there were three lines with my stepmother’s, my brother’s, and my name printed below. The lines above Michiko’s and Jumpei’s names already had their signatures and official seals; the last line was blank, waiting for my signature.
